Application for Schengen Visa This application form is free

1. Surname(s) (family name(s))

FOR EMBASSY / CONSULATE USE ONLY

2. Surname(s) at birth (earlier family name(s))

Date application :

3. First names 4. Date of birth (year-month-day)

5. ID-number (optional)

File handled by :

6. Place and country of birth 7. Current nationality/ies

8. Original nationality (nationality at birth)

9. Sex

10. Marital status :

Male

Female

Single Married Widow(er) Other

11. Father’s name

Separated Divorced

Supporting documents: Valid passport Financial means : Invitation Means of transport

12. Mother’s name

Health insurance

13. Type of passport:

Other

National passport Diplomatic passport Service passport Travel document (1951 Convention) Alien’s passport Seaman’s passport Other travel document (please specify): 14. Number of passport

15. Issued by

16. Date of issue

17. Valid until

18. If you reside in a country other than your country of origin, have you permission to return to that country?

No

Yes, (number and validity)

* 19. Current occupation Visa : * 20. Employer and employer’s address and telephone number. For students, name and address of school.

21. Main destination

22. Type of Visa : Airport transit

Transit

Short stay

24. Number of entries requested

Single entry

Two entries

23. Visa : Individual

Long stay

Collective

Refused Granted Characteristics of Visa : LTV A B C D D+C

25. Duration of stay

Multiple entries Visa is requested for:

days

Number of entries :

26. Other visas (issued during the past three years) and their period of validity

1

Yes , valid until:

Multiple

Valid from To

27. In the case of transit, have you an entry permit for the final country of destination?

No

2

Issuing authority:

* 28. Previous stays in this or other Schengen states

Valid for :

* The questions marked with * do not have to be answered by family members of EU or EEA citizens (spouse, child or dependent ascendant). Family members of EU or EEA citizens have to present documents to prove this relationship. 29. Purpose of travel

Tourism Business Visit to Family or Friends Medical reasons Other (please specify):

Cultural/Sports

Official

FOR EMBASSY / CONSULATE USE ONLY

* 30. Date of arrival

* 31. Date of departure

* 32. Border of first entry or transit route

33. Means of transport

* 34. Name of host or company in the Schengen states and contact person in host company. If not applicable, give name of hotel or temporary address in the Schengen states Name Telephone and telefax

Full address

e-mail address

* 35. Who is paying for your cost of travelling and for your costs of living during your stay?

Myself Host person/s documentation

Host company. (State who and how and present corresponding

* 36. Means of support during your stay

Cash Travellers' cheques Credit cards Travel and/or health insurance. Valid until: 37. Spouse’s family name 39. Spouse’s first name

Accommodation Other:

38. Spouse’s family name at birth 40. Spouse’s date of birth

41. Spouse’s place of birth

42. Children (Applications must be submitted separately for each passport)

Name 1 2 3

First name

Date of birth

43. Personal data of the EU or EEA citizen you depend on. This question should be answered only by family members of EU or EEA citizens. Name First Name Date of Birth

Nationality

Number of passport

Family relationship : of an EU or EEA citizen 44. I am aware of and consent to the following: any personal data concerning me which appear on this visa application form will be supplied to the relevant authorities in the Scheng en states and processed by those authorities, if necessary, for the purposes of a decision on my visa application. Such data may be input into, and stored in, databases accessible to the relevant authorities in the various Schengen states. At my express r equest, the consular authority processing my application will inform me of the manner in which I may exercise my right to check the personal data concerning me and have them altered or deleted, in particular, should they be inaccurate, in accordance with t he national law of the state concerned. I declare that to the best of my knowledge all particulars supplied by me are correct and complete. I am aware that any false statements will lead to my application being rejected or to the annulment of a visa alread y granted and may also render me liable to prosecution under the law of the Schengen state which deals with the application. I undertake to leave the territory of the Schengen states upon the expiry of the visa, if granted. I have been informed that posses sion of a visa is only one of the prerequisites for entry into the European territory of the Schengen states. The mere fact that a visa has been granted to me does not mean that I will be entitled to compensation if I fail to comply with the relevant provi sions of Article 5.1 of the Schengen Implementing Convention and am thus refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Schengen states.

45. Applicant’s home address

47. Place and date

46. Telephone number

48. Signature (for minors, signature of custodian/guardian)